In 1987, as a 23-year-old medical student at the University of Michigan, openly gay Jim Sullivan already knew that he wanted to do HIV work. It was easy to identify with the patients, most of whom were young gay men, and the experience resonated with his coming-out process.
"When I was in the closet at [ age ] 19, I thought mostly of escape … of maybe going into the priesthood, or of running off to California where my family wouldn't see who I was," Sullivan said. "By the time I was 23, I knew that there was no such thing as escape, and that there didn't need to be. I could be myself, and still have a good, meaningful life. As horribly afraid as I was of HIV as it unfolded around me, I knew that facing it head-on all day was the answer."
Though the disease was exploding in New York, California and elsewhere, there were only a limited number of cases in Michigan at the time. So, as a senior, Sullivan went west, to work an elective rotation at San Francisco General Hospital.
"It was incredible, emotional and very intense," Sullivan said. "When I came back [ to the Midwest ] from San Francisco, I knew that this path would be right for me for the rest of my life."
During the day in San Francisco, he saw young men dying horribly, by the dozens, "and the best we could do was give them another year or two."
Sullivan also found a freedom in San Francisco, and friends, and role models … and "a calling" to the field of HIV medicine, he said.
"I was very afraid that I would catch HIV myself … hey, I was gay and 23. I knew the statistics," said Sullivan, who went out to bars in Detroit and Ann Arbor, and to gay student group activities at Michigan. "As I dated and accumulated [ gay ] friends, I always kept in my mind a sense that something awful was enveloping us."
None of his friends during those years knew they had HIV/AIDS, but within a few years after leaving medical school, "the calls began coming," Sullivan recalled.
First was a fraternity brother, who was dead at 24. Then an ex-boyfriend. Then a close bar-hopping buddy.
"The scope of the problem was under-estimated in the early-1980s by the people who were at-risk of contracting it," Sullivan said. "I guess that hasn't changed much, has it?"
As a medical student, Sullivan got his first true, up-close exposure to the disease—through his patients. Longer term follow-up of patients began in 1992, when he returned to Rush Medical Center in Chicago to start his infectious disease fellowship. "Those were grim years, the patients died … in crops," he said. "They were so sick. They would hobble along, accumulating complication after complication, as their last few T cells evaporated."
In 1996, Sullivan left his initial post at University of Illinois at Chicago Medical Center, and entered clinical practice at St. Joseph Hospital in Lakeview. That's where he began developing relationships with patients that have endured in many cases to this day. And 1996 also was the year that protease inhibitors came into use, allowing for three-drug highly active regimens which could fully suppress HIV to undetectable levels.
"That was a momentous change, such a miracle," he said. "All of a sudden, these people who should have been dead, well, they were alive. It was an incredible thing to see. So much hope, [ things were ] so much better. I remember that time very well."
Sullivan now does HIV/AIDS work from four- to seven-hours per day, every day, often more. Most of the work is done at a private practice where, four days a week, he treats 300 to 350 patients. He also spends a half day per week at Laboure Clinic, which serves indigent patients at St Joseph Hospital. There, he mentors medical students and residents while seeing the patients.
"One of the things I really like about my current practice, where there are five doctors in my group, is … we have stuck to a policy where, when one of our patients is admitted to the hospital [ due to HIV/AIDS ] , the doctor who knew him in the office goes to see him in the hospital. That has become very rare as clinics grow larger, and as hospitalists stand in for the outpatient doctors who knew the patients as people before they got so sick," Sullivan said.
Now 48 and living in Chicago's Lakeview neighborhood, Sullivan is the Director of Laboure HIV Clinic at St. Joseph's Hospital. He has been working in the HIV/AIDS world for about 25 years. He performed research while he trained at Rush, and worked on studies at UIC and through the CPCRA at St Joseph.
"I am very proud to say that I enrolled several patients in the SMART study, which was such a turning point in our understanding of HIV management," Sullivan said.
His role now is purely clinical.
"There's no question that the therapies [ for treating HIV/AIDS patients ] are much, much more effective. Over the past 10 years or so, it has mostly been about refining them, about finding out which are the least toxic," Sullivan said. "Most people diagnosed today easily can live 20 years or more on the medicines now available. It's so much better than medicines of years ago. And, it is utterly foolish to avoid testing and not know you have it, if you have it. Young men who wait too long still die … and that just should not happen any more."
But still advances need to be made, he added.
"I think there are still some questions open about what to do for patients with a very high, stable T-cell count, and those low viral load patients," he said. "Also, one of the biggest problems is keeping people on medicines and keeping them adherent to the medicines." Many change providers and change locations of care, thus, many end up off their treatment.
"The most common reason people stop their medicine is: they lose their job, lose their insurance, and some cannot figure out what to do, so they fall out of care. Frankly, the whole system is sick. There are so many programs to keep people on track, and yet, so many go off track every year.
"Another really exciting thing [ over ] the last two years has been the dawning realization that treatment is prevention. Undetectable patients basically don't transmit. If we could find everyone with HIV and successfully treat them soon after they catch it, the epidemic would stop claiming new people. That's a big IF, though."
Despite the medical advances that continue, Sullivan is not convinced medical marvels will ever find a cure for HIV/AIDS.
"I know that everyone hopes for a cure, but I don't think there will be a cure at all," he said. "After all these years and all we know, I don't think that we'll ever be able to cure people."
It's frustrating, yes, Sullivan said, but not the end of the world, so to speak.
"Your future can be bright, but with HIV, it is still always there, absolutely," he said. "Sure, you may be doing wonderfully and have an undetectable viral load and be taking your pills. But stop your pills and you'll lose all that. It's different from other diseases in that … you're never really free of it.
"But we do have a really good solution for almost everyone now. Patients now will, or can, live for a long time. But, they will have to see the doctor four- to six-times annually, and take pills daily, for the rest of their life. If they can become the master of that [ regimen ] , then they can pretty much live a normal life."
